| Doctor Name: | JACK ARTHUR PEVERILL |
| NPI Number: | 1780875906 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PY 3601 |
| Business Practice Address: | 2163 South Tamiami Trail Osprey, FL - 342299696 |
| Business Phone Number: | 9419246113 |
| Business Fax Number: | 9419246113 |
| Mailing Address: | 4724 Acorn Circle, SARASOTA |
| State: | FL |
| Postal Code: | 342333935 |
| Phone Number: | 9419246113 |
| Fax Number: | 9419246113 |
| NPI Enumeration Date: | 08/05/2007 |
| NPI Last Update Date: | 08/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | PY 3601 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |